A small but concerning new pilot study suggests that erythritol, a popular sugar substitute found in many low-calorie and keto-friendly products, may increase the risk of blood clots and heart attacks.

The study, led by researchers at the Cleveland Clinic, found that consuming a drink containing erythritol more than doubled the risk of blood clotting in 10 healthy participants.

Erythritol and Blood Clots

The research, published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, compared the effects of erythritol and sugar on platelet activity in two groups of 10 healthy participants. Each group fasted overnight and then drank a beverage containing 30 grams of either erythritol or glucose (sugar).

After 30 minutes, researchers measured the participants' blood platelet activity.

The study found that erythritol significantly increased platelet responsiveness, or clotting, in all 10 participants. In contrast, those who consumed the sugar beverage showed no changes in platelet activity.

Erythritol's Cardiovascular Risks

This isn't the first time erythritol has raised concerns about its cardiovascular effects. A previous study led by the same research team, published in 2023, found that people with high levels of erythritol in their blood were twice as likely to have a heart attack or stroke.

Erythritol and Stroke Risk

The 2023 study examined blood samples from over 4,000 individuals in the United States and Europe, concluding that higher erythritol levels were significantly linked to an increased risk of heart attack, stroke, and death.

Erythritol and Blood Clot Formation in Mice

The study also found that erythritol caused blood clots in mice.

Erythritol's Prevalence

Erythritol is a common ingredient in many low-calorie and keto-friendly products, including protein bars, yogurt, cookies, ice cream, and even some alcoholic beverages. It's also a key sweetener in stevia and monk fruit blends.

Experts React to the Findings

While the new study is small and requires further investigation, it adds to growing concerns about the potential cardiovascular risks associated with erythritol.

Experts Urge Caution

Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, said the study is “very intriguing and interesting” but urges consumers to interpret the findings with caution.

Industry Pushback

The Calorie Control Council, an industry association representing the low- and reduced-calorie food and beverage industry, dismissed the findings as a result of an “excessive amount of erythritol” given to the participants.

Industry Claims

The council claims that erythritol has been “proven safe and effective” for 30 years. They also argue that the dosage used in the study was far higher than the typical amount found in commercially available products.

Study Authors Respond

Lead study author Dr. Stanley Hazen responded by stating that the amount of erythritol used in the study (30 grams) was equivalent to what is found in typical sugar-free sodas, ice creams, or muffins, of which people often eat more than one.

Potential Long-Term Risks

The study's findings suggest that even moderate consumption of erythritol might have a lasting impact on blood clotting risk.

The Importance of Long-Term Studies

Dr. Wai Hong Wilson Tang, research director for heart failure and cardiac transplantation at the Cleveland Clinic and a coauthor of the study, said, “This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect.”

Recommendations for Consumers

In light of these findings, experts recommend limiting or avoiding erythritol-sweetened products.

Alternatives to Erythritol

Dr. Hazen suggests that consumers opt for moderate amounts of natural sweeteners, such as sugar, glucose, honey, or fruit, which don’t appear to have the same clotting risks as erythritol.

Focus on Whole Foods

Alice H. Lichtenstein, a professor and director of the cardiovascular nutrition laboratory at Tufts University, advises people to drink water and seltzer and limit their consumption of foods and beverages packed with sugar or sweeteners.

Considering the Risks and Benefits

Joanne Slavin, a professor in the department of food science and nutrition at the University of Minnesota-Twin Cities, suggests that consumers carefully consider the risks and benefits of alternative sweeteners.

Call for Further Research

The Cleveland Clinic study highlights the need for further research into the long-term health effects of erythritol, especially in people who are already at high risk for heart disease.

The Ongoing Debate

The debate about the safety of artificial sweeteners continues, with experts urging further investigation into their potential health implications. While erythritol is still considered “generally recognized as safe” by the FDA, the growing body of research suggests that we may need to reconsider our reliance on this popular sugar substitute.

A Sweet Solution?

The search for healthy and satisfying alternatives to sugar remains ongoing.

Focus on Whole Foods

The most important step is to prioritize whole foods in their natural state and limit our consumption of processed foods and beverages high in added sugar or artificial sweeteners.

Moderation is Key

As with many things in life, moderation is key.

The Power of Informed Choices

By being informed about the potential risks and benefits of different sweeteners, we can make empowered choices that support our long-term health and wellbeing.

A Healthy Future

Ultimately, the goal is to find a sweet spot for our health and enjoyment, balancing the cravings for sweetness with the need to make choices that promote our cardiovascular health.